An accident date is required for Federal program when an accident related diagnosis is present.
What this means: Some claims to this payer may reject for 'An accident date is required for Federal program when an accident related diagnosis is present.'
Provider action: Check the codes on the claims, are they considered accident codes? If so you will need to submit an accident indicator and and accident date on your claim.
Rejection Removal: Rejections will not be removed by Gateway EDI as they are valid.
Re-filing: Once this is corrected, you would want to re-file any claims that rejected for this reason.
An invalid code value was encountered. Element PAT01 (Individual Relationship Code) does not contain
What this means: Claims to this payer may reject for 'An invalid code value was encountered. Element PAT01 (Individual Relationship Code) does not contain a [OTER].'
Provider action: Verify that you are not sending the same insured and patient name on the claims, if so correct and resubmit.
Rejection Removal: Rejections will not be removed by Gateway EDI as they are valid.
Re-filing: Once this is corrected, you would want to re-file any
RENDERING PHYSICIAN IS REQUIRED
What this means: There are two possible reasons for this
rejection:
1. If the provider sends the claim with only the individual NPI in the billing loop and they are credentialed with a group NPI, then the claims will be rejected by the payer.
2. If the provider sends the claim with only the individual NPI in the billing loop and the entity type qualifier is 2 (non-person), then the claims will be rejected by the payer.
Resubmit with Group NPI (Box 33) information.
Medicare Guideline posts
- Home
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation process - how often provide need to do - FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Subscribe to:
Post Comments (Atom)
Top Medicare billing tips
-
CPT CODE and Description CPT 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires thes...
-
Procedure code and description 11400- Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion d...
-
URIBEL- methenamine, sodium phosphate, monobasic, monohydrate, phenyls alicylate, methylene blue, and hyoscyamine sulfate capsule Uribel i... -
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
-
LAPAROSCOPY ; LAPAROSCOPIC SURGERY Procedures and Related CPT and ICD-9 Procedure Codes CPT Code CPT Description ICD -9 ...
-
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee... -
Procedure code and description 93224 - External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage;...
-
procedure code and description 11042 -Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 square cm ...
-
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr... -
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 - Private insurance pay upt...
No comments:
Post a Comment